The European Forum for Primary Care (http://www.euprimarycare.org/) aims to improve the health of populations by promoting strong Primary Care, by advocating primary care and by generating data and evidence on Primary Care and exchanging information between its members.
The EFPC organized two workshops with the participation of European experts in Nicosia (7 May 2009) and in Oradea, Romania (9 September 2009) on the integration of sexual and reproductive health in primary care and the results of the workshops were published in ‘Quality in Primary Care’ in August 2010 (Citation1). During the 3rd Biannual EFPC Conference on the Future of Primary Care in Europe, which was held in Pisa, Italy on 28 August 2010, the Health Transformation Programme in Turkey was discussed, among many other topics. As a result of the discussions during the conference, the EFPC took the initiative to organize a meeting on ‘Integration of Sexual and Reproductive Health in Primary Care’ in close collaboration with the World Health Organization, the UNFPA, the International Children's Centre (ICC) and the Turkish Ministry of Health (MoH) on 9 December 2010 in Ankara/Turkey. In the meeting, the integration of sexual and reproductive health in primary care has been discussed by referring to experiences in other European countries and international organizations working on this specific theme.
The objectives of the meeting were:
To review integration of sexual and reproductive health in primary care studies.
To share the country experiences and the success stories in the countries of Europe, which have adopted Family Medicine implementation earlier than Turkey.
To stimulate the development of standards in providing sexual and reproductive health services in primary care and offer recommendations for the implementation of the identified standards and increasing the capacity of family physicians and staff working in sexual and reproductive health.
The Turkish Ministry of Health has been going through an administrative restructuring within the framework of the ‘Health Transformation Programme’ that was put into practice in July 2010. The most striking change within the transformation is the start of the implementation of Family Medicine. The Ministry of Health redefined the definition of primary health care services by including diagnostic and treatment services as well as rehabilitation services into the primary health care level. Within the new health care model and the renewed concept of primary health services, the family physicians have a crucial role.
The Health Transformation Programme implemented by the Ministry of Health is a very important step towards restructuring the health care sector in Turkey. To reach the ultimate aim of the Ministry of Health, i.e. to improve the health level, reproductive health services should be integrated into the primary health care services.
Within the framework of Health Transformation Programme in the last seven years, maternal and child health programmes are discussed as a priority. It has been accepted that the most effective approach in closing the gap between the developed and the developing countries is investing on reproductive health services. Turkey is taking solid steps towards the goal in this regard, the unmet needs for family planning are being resolved and the proportion of women using modern contraceptive methods has now reached 46%.
According to the participants in the meeting, further improvements for in-service training for Primary Care professionals in relation to SRH are required. For this, a Trainer of Trainers (ToT) system has to be developed.
A complaint that was heard very often was the high number of patients per GP that made it difficult to pay sufficient attention to SRH related needs. Besides the solution to decrease the number of patients per GP, other solutions were proposed like sharing tasks and responsibilities with other PC professionals like nurses, midwives, social work, etc.
Clinical Guidelines are available but as often in many countries, these were developed mainly by medical specialists and top-down implemented. Ownership is the key when it comes to changes in clinical behaviour and so the need for new clinical guidelines that are developed with the involvement of the PHC professionals in charge, ideally including the input of patients/clients, is needed.
The presence of many MoH representatives from different departments at the meeting is promising, as it indicates the interest to listen to the stakeholders involved and might results in further changes and improvements in the integration of SRH within Primary Care.
Reference
- Ketting E, Esin A. Integrating sexual and reproductive health in primary health care in Europe: Position paper of the European Forum for Primary Care. Qual Prim Care 2010;18: 269–82.